Stents with radiopaque markers

ABSTRACT

Various embodiments of stents with radiopaque markers disposed within depots in the stent, are described herein.

CROSS REFERENCE

This application is a continuation of application Ser. No. 11/325,973,filed on Jan. 4, 2006. Application Ser. No. 11/325,973 is incorporatedherein by reference it its entirety, including all of the figures.

BACKGROUND OF THE INVENTION Field of the Invention

This invention relates to implantable medical devices, such as stents.In particular, the invention relates to polymeric stents with radiopaquemarkers.

Description of the State of the Art

This invention relates to radially expandable endoprostheses, which areadapted to be implanted in a bodily lumen. An “endoprosthesis”corresponds to an artificial device that is placed inside the body. A“lumen” refers to a cavity of a tubular organ such as a blood vessel. Astent is an example of such an endoprosthesis. Stents are generallycylindrically shaped devices, which function to hold open and sometimesexpand a segment of a blood vessel or other anatomical lumen such asurinary tracts and bile ducts. Stents are often used in the treatment ofatherosclerotic stenosis in blood vessels. “Stenosis” refers to anarrowing or constriction of the diameter of a bodily passage ororifice. In such treatments, stents reinforce body vessels and preventrestenosis following angioplasty in the vascular system. “Restenosis”refers to the reoccurrence of stenosis in a blood vessel or heart valveafter it has been treated (as by balloon angioplasty, stenting, orvalvuloplasty) with apparent success.

The structure of stents is typically composed of scaffolding thatincludes a pattern or network of interconnecting structural elements orstruts. The scaffolding can be formed from wires, tubes, or sheets ofmaterial rolled into a cylindrical shape. In addition, a medicated stentmay be fabricated by coating the surface of either a metallic orpolymeric scaffolding with a polymeric carrier. The polymericscaffolding may also serve as a carrier of an active agent or drug.

The first step in treatment of a diseased site with a stent is locatinga region that may require treatment such as a suspected lesion in avessel, typically by obtaining an x-ray image of the vessel. To obtainan image, a contrast agent, which contains a radiopaque substance suchas iodine is injected into a vessel. “Radiopaque” refers to the abilityof a substance to absorb x-rays. The x-ray image depicts the lumen ofthe vessel from which a physician can identify a potential treatmentregion. The treatment then involves both delivery and deployment of thestent. “Delivery” refers to introducing and transporting the stentthrough a bodily lumen to a region in a vessel that requires treatment.“Deployment” corresponds to the expanding of the stent within the lumenat the treatment region. Delivery and deployment of a stent areaccomplished by positioning the stent about one end of a catheter,inserting the end of the catheter through the skin into a bodily lumen,advancing the catheter in the bodily lumen to a desired treatmentlocation, expanding the stent at the treatment location, and removingthe catheter from the lumen. In the case of a balloon expandable stent,the stent is mounted about a balloon disposed on the catheter. Mountingthe stent typically involves compressing or crimping the stent onto theballoon. The stent is then expanded by inflating the balloon. Theballoon may then be deflated and the catheter withdrawn. In the case ofa self-expanding stent, the stent may be secured to the catheter via aretractable sheath or a sock. When the stent is in a desired bodilylocation, the sheath may be withdrawn allowing the stent to self-expand.

The stent must be able to simultaneously satisfy a number of mechanicalrequirements. First, the stent must be capable of withstanding thestructural loads, namely radial compressive forces, imposed on the stentas it supports the walls of a vessel lumen. In addition to havingadequate radial strength or more accurately, hoop strength, the stentshould be longitudinally flexible to allow it to be maneuvered through atortuous vascular path and to enable it to conform to a deployment sitethat may not be linear or may be subject to flexure. The material fromwhich the stent is constructed must allow the stent to undergoexpansion, which typically requires substantial deformation of localizedportions of the stent's structure. Once expanded, the stent mustmaintain its size and shape throughout its service life despite thevarious forces that may come to bear thereon, including the cyclicloading induced by the beating heart. Finally, the stent must bebiocompatible so as not to trigger any adverse vascular responses.

In addition to meeting the mechanical requirements described above, itis desirable for a stent to be radiopaque, or fluoroscopically visibleunder x-rays. Accurate stent placement is facilitated by real timevisualization of the delivery of a stent. A cardiologist orinterventional radiologist can track the delivery catheter through thepatient's vasculature and precisely place the stent at the site of alesion. This is typically accomplished by fluoroscopy or similar x-rayvisualization procedures. For a stent to be fluoroscopically visible itmust be more absorptive of x-rays than the surrounding tissue.Radiopaque materials in a stent may allow for its direct visualization.

In many treatment applications, the presence of a stent in a body may benecessary for a limited period of time until its intended function of,for example, maintaining vascular patency and/or drug delivery isaccomplished. Therefore, stents fabricated from biodegradable,bioabsorbable, and/or bioerodable materials may be configured to meetthis additional clinical requirement since they may be designed tocompletely erode after the clinical need for them has ended. Stentsfabricated from biodegradable polymers are particularly promising, inpart because they may be designed to completely erode within a desiredtime frame.

However, a significant shortcoming of biodegradable polymers (andpolymers generally composed of carbon, hydrogen, oxygen, and nitrogen)is that they are radiolucent with no radiopacity. Biodegradable polymerstend to have x-ray absorption similar to body tissue.

One way of addressing this problem is to attach radiopaque markers tostructural elements of the stent. A radiopaque marker can be disposedwithin a structural element in such a way that the marker is secured tothe structural element. However, the use of stent markers on polymericstents entails a number of challenges. One challenge relates to thedifficulty of insertion of markers.

Another challenge pertains to the fact that some regions of polymericstruts tend to undergo significant deformation or strain during crimpingand expansion. In particular, such changes are due to plasticdeformation of polymers. Thus, during stent deployment, the portion of astent containing an element may crack or stretch as stress is beingapplied to the expanding stent. As a result, the marker may becomedislodged.

SUMMARY OF THE INVENTION

Embodiments of the present invention are directed to a stent including adeformed radiopaque marker disposed in a depot in a portion of thestent. The marker may be coupled to the portion at least partially by aninterference fit between an expanded portion of the marker and aninternal surface of the portion of the stent within the depot. In anembodiment, at least some gaps between the deformed marker and theinternal surface may be filled with a polymeric coating material. Themarkers may include sufficient radiopacity to be imaged by an imagingtechnique.

Further embodiments of the present invention are directed to a method offabricating a stent that may include disposing a radiopaque marker in adepot in a portion of the stent and compressing the marker to couple themarker within the depot. In an embodiment, compressing the marker mayexpand a portion of the marker within the depot to create aninterference fit between the expanded portion and an internal surface ofthe stent within the depot. The method may further include applying acoating material to fill gaps between the deformed marker and theinternal surface.

Other embodiments of the present invention are directed to a stentincluding a radiopaque marker disposed in a depot in a portion of thestent such that the marker may be coupled to the stent at leastpartially by an interference fit between the marker and a deformedportion of the stent adjacent to the depot.

Additional embodiments of the present invention are directed to a stentincluding a radiopaque marker disposed in a depot in a portion of thestent that is configured to accommodate the marker such that a surfaceof the portion adjacent to the depot may include a recess. The recessmay facilitate deformation of the portion when the marker is disposedwithin the depot so as to facilitate coupling of the marker to theportion.

Additional embodiments of the present invention are directed to a stentincluding a marker disposed within a depot in a portion of the stentsuch that the stent may have regions with a lower strain than otherhigher strain portions when the stent is placed under an applied stressduring use. The depot may be selectively positioned in a selected regionof lower strain.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 depicts a three-dimensional view of a cylindrically-shaped stent.

FIG. 2 depicts one embodiment of a stent pattern with a depot forreceiving a marker.

FIG. 3 depicts view of a stent pattern with a marker depot.

FIGS. 4A-B depict an overhead and side view of the portion of the stentfrom FIG. 3 with the marker depot.

FIG. 5 depicts a cylindrical marker and a portion of a stent with amarker depot.

FIG. 6 depicts a spherical marker and a portion of a stent with a markerdepot.

FIG. 7 depicts a spherical marker disposed within a depot in a stent.

FIG. 8A depicts a side view of an uncompressed spherical marker in adepot.

FIG. 8B depicts a side view of a compressed spherical marker in a depot.

FIG. 9A depicts a portion of a stent with a depot including ridges.

FIG. 9B depicts a spherical marker disposed within the depot of FIG. 9A.

FIG. 10A depicts a portion of a stent with a depot having a non-circularcross-section.

FIG. 10B depicts a portion of a stent with a spherical marker disposedwithin the depot in FIG. 10A.

FIGS. 11A-B depict an overhead and side view of a portion of a stentwith relief cuts adjacent to a marker depot.

FIG. 12A depicts a portion of a stent with marker depots in a low strainregion of a stent.

FIG. 12B depicts a portion of a stent with markers disposed in thedepots of FIG. 12A.

FIG. 13 depicts an overhead view of the portion of the stent in FIG.12B.

DETAILED DESCRIPTION OF THE INVENTION

The present invention may be applied to stents and, more generally,implantable medical devices such as, but is not limited to,self-expandable stents, balloon-expandable stents, stent-grafts,vascular grafts, cerebrospinal fluid shunts, pacemaker leads, closuredevices for patent foramen ovale, and synthetic heart valves.

A stent can have virtually any structural pattern that is compatiblewith a bodily lumen in which it is implanted. Typically, a stent iscomposed of a pattern or network of circumferential and longitudinallyextending interconnecting structural elements or struts. In general, thestruts are arranged in patterns, which are designed to contact the lumenwalls of a vessel and to maintain vascular patency. A myriad of strutpatterns are known in the art for achieving particular design goals. Afew of the more important design characteristics of stents are radial orhoop strength, expansion ratio or coverage area, and longitudinalflexibility. The present invention is applicable to virtually any stentdesign and is, therefore, not limited to any particular stent design orpattern. One embodiment of a stent pattern may include cylindrical ringscomposed of struts. The cylindrical rings may be connected by connectingstruts.

In some embodiments, a stent of the present invention may be formed froma tube by laser cutting the pattern of struts in the tube. The stent mayalso be formed by laser cutting a polymeric sheet, rolling the patterninto the shape of the cylindrical stent, and providing a longitudinalweld to form the stent. Other methods of forming stents are well knownand include chemically etching a polymeric sheet and rolling and thenwelding it to form the stent. A polymeric wire may also be coiled toform the stent. The stent may be formed by injection molding of athermoplastic or reaction injection molding of a thermoset polymericmaterial. Filaments of the compounded polymer may be extruded or meltspun. These filaments can then be cut, formed into ring elements, weldedclosed, corrugated to form crowns, and then the crowns welded togetherby heat or solvent to form the stent. Lastly, hoops or rings may be cutfrom tubing stock, the tube elements stamped to form crowns, and thecrowns connected by welding or laser fusion to form the stent.

FIG. 1 depicts a three-dimensional view of a cylindrically-shaped stent10 with struts 4 that form cylindrical rings 12 which are connected bylinking struts 8. The cross-section of the struts in stent 10 isrectangular-shaped. The struts have abluminal faces 20, luminal faces22, and sidewall faces 26. The cross-section of struts is not limited towhat has been illustrated, and therefore, other cross-sectional shapesare applicable with embodiments of the present invention. The patternshould not be limited to what has been illustrated as other stentpatterns are easily applicable with embodiments of the presentinvention.

A stent can be made of a biostable and/or biodegradable polymer. Asindicated above, a stent made from a biodegradable polymer is intendedto remain in the body for a duration of time until its intended functionof, for example, maintaining vascular patency and/or drug delivery isaccomplished. After the process of degradation, erosion, absorption,and/or resorption has been completed, no portion of the biodegradablestent, or a biodegradable portion of the stent will remain. In someembodiments, very negligible traces or residue may be left behind. Theduration can be in a range from about a month to a few years. However,the duration is typically in a range from about one month to twelvemonths, or in some embodiments, six to twelve months. It is importantfor the stent to provide mechanical support to a vessel for at least aportion of the duration. Many biodegradable polymers have erosion ratesthat make them suitable for treatments that require the presence of adevice in a vessel for the above-mentioned time-frames.

In general, polymers can be biostable, bioabsorbable, biodegradable, orbioerodable. Biostable refers to polymers that are not biodegradable.The terms biodegradable, bioabsorbable, and bioerodable, as well asdegraded, eroded, and absorbed, are used interchangeably and refer topolymers that are capable of being completely eroded or absorbed whenexposed to bodily fluids such as blood and can be gradually resorbed,absorbed and/or eliminated by the body.

Biodegradation refers generally to changes in physical and chemicalproperties that occur in a polymer upon exposure to bodily fluids as ina vascular environment. The changes in properties may include a decreasein molecular weight, deterioration of mechanical properties, anddecrease in mass due to erosion or absorption. Mechanical properties maycorrespond to strength and modulus of the polymer. Deterioration of themechanical properties of the polymer decreases the ability of a stent,for example, to provide mechanical support in a vessel. The decrease inmolecular weight may be caused by, for example, hydrolysis, oxidation,enzymolysis, and/or metabolic processes.

Representative examples of polymers that may be used to fabricateembodiments of stents, or more generally, implantable medical devicesinclude, but are not limited to, poly(N-acetylglucosamine) (Chitin),Chitosan, poly(3-hydroxyvalerate), poly(lactide-co-glycolide),poly(3-hydroxybutyrate), poly(4-hydroxybutyrate),poly(3-hydroxybutyrate-co-3-hydroxyvalerate), polyorthoester,polyanhydride, poly(glycolic acid), poly(glycolide), poly(L-lacticacid), poly(L-lactide), poly(D,L-lactic acid), poly(D,L-lactide),poly(L-lactide-co-D,L-lactide), poly(caprolactone),poly(L-lactide-co-caprolactone), poly(D,L-lactide-co-caprolactone),poly(glycolide-co-caprolactone), poly(trimethylene carbonate), polyesteramide, poly(glycolic acid-co-trimethylene carbonate),co-poly(ether-esters) (e.g. PEO/PLA), polyphosphazenes, biomolecules(such as fibrin, fibrinogen, cellulose, starch, collagen, and hyaluronicacid), polyurethanes, silicones, polyesters, polyolefins,polyisobutylene and ethylene-alphaolefin copolymers, acrylic polymersand copolymers, vinyl halide polymers and copolymers (such as polyvinylchloride), polyvinyl ethers (such as polyvinyl methyl ether),polyvinylidene halides (such as polyvinylidene chloride),polyacrylonitrile, polyvinyl ketones, polyvinyl aromatics (such aspolystyrene), polyvinyl esters (such as polyvinyl acetate),acrylonitrile-styrene copolymers, ABS resins, polyamides (such as Nylon66 and polycaprolactam), polycarbonates, polyoxymethylenes, polyimides,polyethers, polyurethanes, rayon, rayon-triacetate, cellulose acetate,cellulose butyrate, cellulose acetate butyrate, cellophane, cellulosenitrate, cellulose propionate, cellulose ethers, and carboxymethylcellulose. Additional representative examples of polymers that may beespecially well suited for use in fabricating embodiments of implantablemedical devices disclosed herein include ethylene vinyl alcoholcopolymer (commonly known by the generic name EVOH or by the trade nameEVAL), poly(butyl methacrylate), poly(vinylidenefluoride-co-hexafluoropropene) (e.g., SOLEF 21508, available from SolvaySolexis PVDF, Thorofare, N.J.), polyvinylidene fluoride (otherwise knownas KYNAR, available from ATOFINA Chemicals, Philadelphia, Pa.),ethylene-vinyl acetate copolymers, poly(vinyl acetate),styrene-isobutylene-styrene triblock copolymers, and polyethyleneglycol.

It is generally desirable to minimize the interference of a stent ormarker with the structure of a lumen and/or with flow of bodily fluidthrough the lumen. Sharp edges, protrusions, etc. in the path of bloodflow can result in formation of turbulent and stagnant zones which canact as a nidus for thrombosis. A smaller and/or smoother profile of abody portion may be more hemocompatible. Additionally, a smaller andsmoother profile presented by a marker has much less likelihood ofcatching on other parts of the delivery system such as the guidewire orguiding catheter. The embodiments of stents with markers discussedherein do not contribute significantly to the form factor, or profile,of the stent in such a way that interferes with the structure of a lumenand/or with flow of bodily fluid through the lumen.

As indicated above, it is desirable to have the capability of obtainingimages of polymeric stents with x-ray fluoroscopy during and afterimplantation. Various embodiments of the present invention includestents with markers disposed within depots or holes in a stent. In anembodiment, the depot may be formed in a structural element by lasermachining. The depot may extend partially or completely through theportion of the stent. For example, an opening of a depot may be on anabluminal or luminal surface and extend partially through the stent orcompletely through to an opposing surface. The markers may besufficiently radiopaque for imaging the stent. In addition, embodimentsof the stents with markers tend to be biocompatible and do not interferewith treatment.

FIG. 2 depicts one embodiment of a stent pattern 40 with depots 44 forreceiving a marker. In FIG. 2, stent pattern 40 is shown in a flattenedcondition showing an abluminal or luminal surface so that the patterncan be clearly viewed. When the flattened portion of stent pattern 40 isin a cylindrical condition, it forms a radially expandable stent. Stentpattern 40 includes cylindrically aligned structural elements 46 andlinking structural elements 48. Depots 44 are located at a region ofintersection of six structural elements or a “spider” region.

FIG. 3 depicts a three-dimensional view of a stent pattern 60 withdepots 62. Stent pattern 60 includes cylindrically aligned structuralelements 64 and linking structural elements 66. Depots 62 are located ina portion 68 which is a region of intersection of four structuralelements. As depicted in FIG. 3, depots 62 have a cylindrical shape andextend completely through the radial thickness of structural elements inportion 68.

FIG. 4A depicts an overhead view of depot 62 in portion 68 from FIG. 3.FIG. 4B is a side view of depot 62 in portion 68 across line A-A in FIG.4A. Depot 62 has a diameter D and extends all the way through portion 68which has a radial thickness T. Portion 68 has a width W_(S) along lineA-A. D may be greater than 60%, 80%, 100%, 110%, 120%, 130%, or 140% ofW_(S).

Certain embodiments of a stent may include a deformed radiopaque markerdisposed in a depot in a portion of the stent. The marker may be coupledto the portion at least partially by an interference fit between anexpanded section of the marker and an internal surface of the portion ofthe stent within the depot. In some embodiments, a marker in anundeformed state may be disposed in a depot and compressed to couple themarker within the depot. Compressing the marker may expand a portion ofthe marker within the depot to create the interference fit. Aftercompressing, the deformed marker may have at least one compressedportion in addition to the expanded portion.

There may be difficulties with the insertion of markers of certainshapes in the depots. For example, it may be necessary to orient oralign a cylindrical element for insertion into a cylindrical depot.Cylindrical markers or slugs can be difficult to insert due to rotationof the slug during insertion.

FIG. 5 depicts an example of a cylindrical marker 70 having acylindrical axis 72. Also shown is a portion 74 of a stent with acylindrical depot 76 having a cylindrical axis 78. During insertion,cylindrical marker 70 can rotate so that its axis 72 is not in alignmentwith axis 78 of depot 76.

However, it is not necessary to orient a spherical marker due to thespherical symmetry of the marker. A spherical marker can be selectedthat has a size that allows the marker to fit into a depot. FIG. 6depicts a spherical marker 80 and a portion 82 of a stent with acylindrical depot 84 with an axis 86.

FIG. 7 depicts the stent pattern of FIG. 3 with a spherical marker 90disposed within depot 62. In some embodiments, the spherical marker maybe completely enclosed within the depot. In other embodiments, themarker may partially project beyond a surface of the stent.

In some embodiments, a marker disposed in a depot may be compressed atthe portions at the openings of the depot. The marker may then expandwithin the depot to create an interference fit. The compressed portionmay correspond to compressed ends with an expanded portion between theends. An interference fit may be between the expanded portion of themarker and the internal surface of the depot. For example, a sphericalmarker may be compressed at two ends and expand about an equator. In anembodiment, the marker may have a size that allows an interference fitwithin the depot. Such an interference fit may be particularly usefulfor markers composed of materials that are relatively easily deformed ormalleable, such as, but not limited to gold.

In one embodiment, a marker may be placed in the depot and then pressedinto place with a small flat tool or a machined fixture. In anembodiment, the marker may be disposed in a depot using a syringe. Themarkers may be held at the end of the syringe by a vacuum or surfacetension of a viscous fluid. In some embodiments, the markers may beheated prior to placement into the depot.

After disposing and compressing the marker, there may be gaps betweenthe marker and the internal surface of the depot. Such gaps may allow amarker to become loose and fall out of the depot. In some embodiments,at least some of the gaps between the deformed marker and the internalsurface may be filled with a polymeric coating. A coating materialcomposed of a polymer dissolved in a solvent may be applied to fill thegaps. The coating material may be applied in various ways known in theart such as by spraying or dipping.

FIG. 8A depicts a side view, as in FIG. 4B, across a portion 104 of astent with a depot 102 with a spherical marker 100 disposed within depot102. FIG. 8B illustrates an interference fit between marker 100 andportion 104. Marker 100 is compressed at ends 106 and 108 which causesexpansion around an equator 112. A void 109 may be filled with apolymeric coating material, as described above.

Some materials that are desirable for use in markers such as platinummay be difficult to compress and deform to create an interference fit.Compressing such materials may cause damage to portions of a stentadjacent to a depot. Therefore, it may be desirable to couple a markerwithin a depot in an undeformed or substantially undeformed statethrough deformation of the stent adjacent to the depot.

In some embodiments, a stent may include a radiopaque marker disposed ina depot in a portion of the stent. The marker may be coupled to thestent at least partially by an interference fit between the marker and adeformed portion of the stent adjacent to the depot. In an embodiment,the marker may be undeformed or substantially undeformed after beingcoupled to the stent. In one embodiment, the deformed portion of thestent within the depot may include deformable projections adapted todeform when the marker is disposed in the depot. The projections mayinclude ridges that are parallel, perpendicular, or between parallel andperpendicular to a cylindrical axis of the depot.

FIG. 9A depicts a portion of a stent pattern with a depot 120 in aspider region 122. Depot 120 has ridges 124. FIG. 9B depicts a sphericalmarker 128 disposed within depot 120 of FIG. 9A. Marker 128 is coupledby an interference fit between undeformed marker 128 and deformed ridges124. Voids 130 are shown between ridges 124. In some embodiments,coupling of the marker within a depot may be facilitated by at leastpartially filling the void with polymeric coating material, as describedabove.

In other embodiments, a depot may have a cross-section different from across-section of the marker. In addition, a length across a portion ofthe depot may be less than a cross-section of a marker. When the markeris disposed with the depot, the portion of the stent may deform tochange the cross-section of the depot to accommodate the marker. Thedeformation of the stent may create an interference fit between themarker and a portion of the surface of the stent within the depot. For amarker with a circular cross-section such as a sphere or cylinder,depots with non-circular cross-sections can be a variety of shapes suchas oval, ellipsoid, rectangular, etc.

FIG. 10A depicts an overhead view of a portion 140 of a stent with adepot 144 having a non-circular cross-section. Depot 144 has a width,W_(O), that is less than a diameter D_(S) of a spherical marker. FIG.10B depicts portion 140 with a spherical marker 146 with diameter D_(S)disposed within depot 144 from FIG. 10A. Portion 140 deforms toaccommodate marker 146 to create an interference fit between marker 146and a portion of the surface of portion 140 within depot 144. Voids 148may be filled with a polymeric coating material, as described above.

As indicated above, positioning a marker within a depot may causedeformation in a portion of the stent adjacent to the depot. It may bedesirable to increase the flexibility of the portion to reduce oreliminate damage to the stent as the portion deforms. In someembodiments, a surface of the portion adjacent to the depot may includea recess. The recess may facilitate deformation or increase theflexibility of the portion when the marker is disposed within the depotso as to facilitate coupling of the marker to the portion.

In one embodiment, the recess may be a groove in communication with thedepot. The surface may include more than one groove of various widthsand depths. For example, a groove may have a width that is less than 1%,3%, 5%, 10%, 15%, 20%, or 20% of a diameter of a depot. Additionally, agroove may have a depth that is less than 1%, 3%, 5%, 10%, 15%, or 20%of a radial thickness of a strut that has the depot.

FIG. 11A depicts an overhead view of a portion 150 of a stent with adepot 154 for a marker. Portion 150 has grooves 158 in communicationwith the depot. FIG. 11B depicts a side view of grooves 158 facing aninternal surface 164 of depot 154. Grooves 158 have depth D_(G) and awidth W_(G). Grooves 158 are depicted with a rectangular cross-section,however, a groove may also have a rounded cross-section.

As indicated above, certain regions of polymeric struts tend to undergosignificant deformation or strain during crimping and expansion. Suchregions include curved or bent regions such as regions 14, 16, and 18 inFIG. 1 as well as regions where structural elements intersect such asportion 68 in FIG. 3. Thus, during stent deployment, the materialsurrounding a depot located in such regions may crack or stretch asstress is being applied to the expanding stent, and the marker maybecome dislodged. Straight or relatively straight portions such assection 19 in FIG. 1 tend to experience relatively low strain evenduring crimping and expansion.

Therefore, in some embodiments, it may be desirable or necessary to havea higher mass or thickness in regions with depots than regions withoutdepots. The higher mass or thickness may reinforce the region which canat least partially compensate for the presence of the depot. A regioncan be reinforced with added mass of stent material so that it canadequately withstand the stress of crimping and expansion withoutsignificant distortion of the structural element in the region of thedepot.

Furthermore, a high strain region tends to require a larger mass tocompensate for the depot than a low strain region. An increase in massof a stent increases the form factor of the stent, which is generallynot desirable.

In certain embodiments, a stent may include a marker disposed within adepot in a portion of the stent. The stent may have regions with a lowerstrain than other higher strain regions when the stent is placed underan applied stress during use. The depot may be selectively positioned ina selected region of lower strain. The selected region of the structuralelement may be modified to have a higher mass or thickness than a regionof lower strain without a marker so as to maintain the load-bearingcapability of the selected region and to inhibit decoupling of themarker from the stent.

FIG. 12A depicts a stent pattern 180 with depots 182 in portion 184, alow strain region of a stent. As shown in FIG. 12A, portion 184 is widerthan a structural element 186 that has no depots. Portion 184 is wideror has more mass to maintain the structural integrity of the stent. FIG.12B depicts spherical markers 188 disposed within depots 182. As shownin FIGS. 12A-B, one of the advantages of disposing markers in low strainregions such as portion 184 is that multiple markers can beaccommodated. Thus, the visibility of the stent in enhanced.

FIG. 13 depicts an overhead view of portion 184 from FIGS. 12A-B. Thepart of portion 184 that is not reinforced has a width W_(L) and a widthof the reinforced part is W_(R). W_(R) may be greater than 120%, 140%,160%, 180%, 200%, 220%, or 250% of W_(L).

In certain embodiments, a spherical marker may additionally oralternatively be coupled within a depot with any suitable biocompatibleadhesive. In one embodiment, the adhesive may include a solvent. Thesolvent may dissolve the polymer of the structural element within thedepot to allow the marker within the depot to be coupled to thestructural element. For markers that include a polymer, a solvent mayalso dissolve a portion of the marker. In another embodiment, theadhesive may include a solvent mixed with a polymer. The solvent or thesolvent-polymer mixture may be applied to the structural element withinthe depot or the marker followed by disposing the marker within thedepot. The solvent may then be removed through evaporation. Evaporationmay be facilitated by, for example, heating the structural element in anoven or by some other method.

Representative examples of solvents may include, but are not limited to,chloroform, acetone, chlorobenzene, ethyl acetate, 1,4-dioxane, ethylenedichloride, 2-ethyhexanol, and combinations thereof. Representativepolymers may include biostable and biodegradable polymers disclosedherein that may be dissolved by the selected solvent.

In other embodiments, adhesives may include, but are not limited to,thermosets such as, for example, epoxies, polyesters and phenolics;thermoplastics such as, for example, polyamides, polyesters and ethylvinyl acetate (EVA) copolymers; and elastomers such as, for example,natural rubber, styrene-isoprene-styrene block copolymers, andpolyisobutylene. Other adhesives include, but are not limited to,proteins; cellulose; starch; poly(ethylene glycol); fibrin glue; andderivatives and combinations thereof.

Mixtures of solvents and another substance can be used to formadhesives. In some embodiments, mixtures of water and sugar such as, forexample, mixtures of water and sucrose, can be used as an adhesive. Inother embodiments, mixtures of PEG, or derivatives thereof, can be mixedwith a suitable solvent to form an adhesive. Suitable solvents for PEG,or derivatives thereof, include, but are not limited to, water, ethanol,chloroform, acetone, and the like.

In other embodiments, the marker can be coupled to the structuralelement by a thermal weld. Prior to disposing the marker in thestructural element, a metallic marker may be heated to a temperaturethat can melt at least a portion of the polymer of the structuralelement. A marker including a polymer can be heated to a temperature ator above its melting temperature prior to disposing the marker in thedepot.

Furthermore, the markers may be coupled to any desired location on astent. In some embodiments, it may be advantageous to limit theplacement of a marker to particular locations or portions of surfaces ofa stent. For example, it may be desirable to couple a marker at asidewall face of a structural element to reduce or eliminateinterference with a lumen wall or interference with blood flow,respectively. To delineate just the margins of the stent so that thephysician may see its full length, markers can be placed only at thedistal and proximal ends of the stent.

Additionally, a device such as a stent may typically include two or moremarkers coupled to various locations of the stent. The markers may bedistributed in a manner that facilitates visualization of the stentduring and after implantation. For instance, the markers may bedistributed circumferentially and longitudinally throughout a stentpattern.

As indicated above, a stent may include a biostable and/or abiodegradable polymer. The biodegradable polymer may be a pure orsubstantially pure biodegradable polymer. Alternatively, thebiodegradable polymer may be a mixture of at least two types ofbiodegradable polymers. The stent may be configured to completely erodeaway once its function is fulfilled.

In certain embodiments, the marker may be biodegradable. It may bedesirable for the marker to degrade at the same or substantially thesame rate as the stent. For instance, the marker may be configured tocompletely or almost completely erode at the same time or approximatelythe same time as the stent. In other embodiments, the marker may degradeat a faster rate than the stent. In this case, the marker may completelyor almost completely erode before the body of the stent is completelyeroded.

Furthermore, a radiopaque marker may be composed of a biodegradableand/or biostable metal. Biodegradable or bioerodable metals tend toerode or corrode relatively rapidly when exposed to bodily fluids.Biostable metals refer to metals that are not biodegradable orbioerodable or have negligible erosion or corrosion rates when exposedto bodily fluids. In some embodiments, metal erosion or corrosioninvolves a chemical reaction between a metal surface and itsenvironment. Erosion or corrosion in a wet environment, such as avascular environment, results in removal of metal atoms from the metalsurface. The metal atoms at the surface lose electrons and becomecharged ions that leave the metal to form salts in solution.

Additionally, it is desirable to use a biocompatible biodegradable metalfor a marker. A biocompatible biodegradable metal forms erosion productsthat do not negatively impact bodily functions.

In one embodiment, the radiopaque marker may be composed of a pure orsubstantially pure biodegradable metal. Alternatively, the marker may bea mixture or alloy of at least two types of metals. Representativeexamples of biodegradable metals for use in a marker may include, butare not limited to, magnesium, zinc, and iron. Representative mixturesor alloys may include magnesium/zinc, magnesium/iron, zinc/iron, andmagnesium/zinc/iron. Radiopaque compounds such as iodine salts, bismuthsalts, or barium salts may be compounded into the metallic biodegradablemarker to further enhance the radiopacity.

Representative examples of biostable metals can include, but are notlimited to, platinum and gold.

In some embodiments, the composition of the marker may be modified ortuned to obtain a desired erosion rate and/or degree of radiopacity. Forexample, the erosion rate of the marker may be increased by increasingthe fraction of a faster eroding component in an alloy. Similarly, thedegree of radiopacity may be increased by increasing the fraction of amore radiopaque metal, such as iron, in an alloy. In one embodiment, abiodegradable marker may be completely eroded when exposed to bodilyfluids, such as blood, between about a week and about three months, ormore narrowly, between about one month and about two months.

In other embodiments, a radiopaque marker may be a mixture of abiodegradable polymer and a radiopaque material. A radiopaque materialmay be biodegradable and/or bioabsorbable. Representative radiopaquematerials may include, but are not limited to, biodegradable metallicparticles and particles of biodegradable metallic compounds such asbiodegradable metallic oxides, biocompatible metallic salts, gadoliniumsalts, and iodinated contrast agents.

In some embodiments, the radiopacity of the marker may be increased byincreasing the composition of the radiopaque material in the marker. Inone embodiment, the radiopaque material may be between 10% and 80%; 20%and 70%; 30% and 60%; or 40% and 50% by volume of the marker.

The biodegradable polymer in the marker may be a pure or substantiallypure biodegradable polymer. Alternatively, the biodegradable polymer maybe a mixture of at least two types of biodegradable polymers. In oneembodiment, the composition of the biodegradable polymer may be modifiedto alter the erosion rate of the marker since different biodegradablepolymers have different erosion rates.

A biocompatible metallic salt refers to a salt that may be safelyabsorbed by a body. Representative biocompatible metallic salts that mayused in a marker include, but are not limited to, ferrous sulfate,ferrous gluconate, ferrous carbonate, ferrous chloride, ferrousfumarate, ferrous iodide, ferrous lactate, ferrous succinate, bariumsulfate, bismuth subcarbonate, bismuth potassium tartrate, bismuthsodium iodide, bismuth sodium tartrate, bismuth sodium triglycollamate,bismuth subsalicylate, zinc acetate, zinc carbonate, zinc citrate, zinciodate, zinc iodide, zinc lactate, zinc phosphate, zinc salicylate, zincstearate, zinc sulfate, and combinations thereof. The concentration ofthe metallic salt in the marker may be between 10% and 80%; 20% and 70%;30% and 60%; or 40% and 50% by volume of the marker.

In addition, representative iodinated contrast agents may include, butare not limited to acetriozate, diatriozate, iodimide, ioglicate,iothalamate, ioxithalamate, selectan, uroselectan, diodone, metrizoate,metrizamide, iohexol, ioxaglate, iodixanol, lipidial, ethiodol, andcombinations thereof. The concentration of an iodinated contrast agentin the marker may be between 5% and 80%; 20% and 70%; 30% and 60%; or40% and 50% by volume of the marker.

The composition of metallic particles may include at least thosebiodegradable metals discussed above as well as metallic compounds suchas oxides. The concentration of metallic particles in the marker may bebetween 10% and 80%; 20% and 70%; 30% and 60%; or 40% and 50% by volumeof the marker. Additionally, individual metallic particles may be a pureor substantially pure metal or a metal compound. Alternatively,individual metallic particles may be a mixture of at least two types ofmetals or metallic compounds. Individual metallic particles may also bea mixture or an alloy composed of at least two types of metals.

In certain embodiments, the metallic particles may be metallicnanoparticles. A “nanoparticle” refers to a particle with a dimension inthe range of about 1 nm to about 100 nm. A significant advantage ofnanoparticles over larger particles is that nanoparticles may dispersemore uniformly in a polymeric matrix, which results in more uniformproperties such as radiopacity and erosion rate. Additionally,nanoparticles may be more easily absorbed by bodily fluids such as bloodwithout negative impact to bodily functions. Representative examples ofmetallic particles may include, but are not limited to, iron, magnesium,zinc, platinum, gold, and oxides of such metals.

In one embodiment, the composition of different types of metallicparticles in the mixture as well as the composition of individualparticles may be modified to alter erosion rates and/or radiopacity ofthe marker. In addition, the ratio of polymer to metallic particles maybe modified to alter both the erosion rate and radiopacity.

A marker may be fabricated by methods including, but not limited to,molding, machining, assembly, or a combination thereof. All or part of ametallic or polymeric marker may be fabricated in a mold or machined bya method such as laser machining.

While particular embodiments of the present invention have been shownand described, it will be obvious to those skilled in the art thatchanges and modifications can be made without departing from thisinvention in its broader aspects. Therefore, the appended claims are toencompass within their scope all such changes and modifications as fallwithin the true spirit and scope of this invention.

1-20. (canceled)
 21. A radially expandable stent comprising: abiodegradable polymeric pattern of cylindrical rings and linking struts,the cylindrical rings being connected by the linking struts, markersdisposed in depots of the stent, wherein the markers comprise asufficient radiopacity to be imaged by an imaging technique, wherein themarkers are coupled to the stent at least partially by an interferencefit between the markers and a portion of an internal surface of thedepots, at least some gaps between the markers and the internal surfaceof the depots include a biocompatible polymeric material that acts as anadhesive for the markers, and wherein the stent includes two or moremarkers distributed in a manner that facilitates visualization of thestent during and after implantation, and each depot comprises only onemarker.
 22. The stent of claim 21, wherein the biodegradable polymericpattern of cylindrical rings and linking struts is fabricated from apolymer including any of the following: poly(glycolide), poly(L-lacticacid) ((poly(L-lactide)), poly(D,L-lactic acid) ((poly(D,L-lactide)),poly(L-lactide-co-D,L-lactide), poly(caprolactone),poly(L-lactide-co-caprolactone), poly(D,L-lactideco-caprolactone),poly(glycolide-co-caprolactone).
 23. The stent of claim 21, wherein themarkers are undeformed or substantially undeformed after being coupledto the stent.
 24. The stent of claim 21, wherein the markers are amixture or alloy of at least two types of metals.
 25. The stent of claim21, wherein the depots extend completely through the stent.
 26. Thestent of claim 21, wherein the depots extend only partially through thestent.
 27. The stent of claim 26, wherein openings for the depots are onan abluminal surface.
 28. The stent of claim 21, wherein the markers arecylindrical markers.
 29. A stent comprising a deformed sphericalradiopaque marker disposed in a depot in a portion of the stent, themarker being coupled to the portion at least partially by aninterference fit between an expanded portion of the marker and aninternal surface of the portion of the stent within the depot, whereinthe marker comprises sufficient radiopacity to be imaged by an imagingtechnique, and wherein at least some gaps between the deformed markerand the internal surface are filled with a polymeric coating material.30. The stent of claim 29, wherein the marker further comprises at leastone compressed portion, the expanded and compressed portions arisingfrom deforming an undeformed or partially deformed marker disposedwithin the depot.
 31. The stent of claim 29, wherein the depot iscylindrically-shaped.
 32. The stent of claim 29, wherein the stentcomprises a biostable and/or biodegradable polymer.
 33. A stentcomprising: a radiopaque marker disposed in a depot in a portion of thestent, wherein the marker comprises a sufficient radiopacity to beimaged by an imaging technique, wherein the marker is on the portionthat connects two bending elements of the stent at an apex of eachbending element, the apices pointing toward and aligned with oneanother, and the stent is fabricated from a polymer and the marker is amixture or alloy of at least two types of metals for allowing the markerto be imaged by the imaging technique.
 34. The stent of claim 33,wherein the stent polymer includes poly(L-lactide-co-caprolactone).